Cleo Libonati, RN, BSN

Understanding Riboflavin (Vitamin B2) Deficiency in Celiac Disease

by Cleo Libonati, RN, BSN on August 11th, 2010


Riboflavin is a micronutrient, also known as Vitamin B2, which performs many important functions in the body. Riboflavin is a water-soluble vitamin that releases energy from carbohydrates, amino acids, and lipids. It plays a key role in specific amino acid production and provides antioxidant protection. Riboflavin is essential for growth and production of red blood cells and maintaining healthy skin, eyes, hair, and nervous system.

Riboflavin Deficiency

More than 34% of Americans get less than the RDA because, unlike other vitamins, riboflavin is not found in many foods.

Riboflavin depletion and/or deficiency is common before starting the gluten-free diet treatment. It frequently results from malabsorption due to damage to the small intestinal lining, but can also be depleted by excretion through diarrhea, excessive sweating or excessive urination. It is important to note that riboflavin deficiency can result from low serum proteins, which is a common occurrence in untreated celiac disease.

When riboflavin deficiency appears after starting the gluten-free diet, it is usually due topoor dietary intake. Deficiency of riboflavin is normally part of a multiple-nutrient deficiency involving other B vitamins. However, because it can be produced by beneficial intestinal bacteria (flora), the deficiency may not cause symptoms as severe as other vitamin deficiencies, provided the flora is healthy.

Deficiency Symptoms

Riboflavin deficiency symptoms involve problems with digestion, the mouth, eyes, skin, nervous system, strength, and blood cell production.

 

1. Digestive problems:

· Constipation.

· Indigestion.

· Gas.

· Abdominal pain.

2. Problems around the mouth.

· Sensitivity or inflammation of the mucous membranes.

· Soreness with magenta-colored tongue (normal pink takes on purplish cast).

· Subsequent atrophy or hypertrophy of papillae (taste buds) can develop.

· Reddening of lips that may develop tiny fissures.

· Cracking or development of sores at the corners of the mouth.

 

3. Visual problems:

· Eye fatigue.

· Tearing, burning and itching in and around the eyes or a dry, sandy feeling

of the eyes.

· Blurry vision.

· Eye redness or excessive sensitivity to light.

· Cataracts may occur more frequently with riboflavin deficiency.

4. Skin problems:

· Seborrhea (a greasy, red, scaly eruption) and/or peeling may involve the nasolabial folds, ears, eyes, scrotum, or vulva.

5. Anemia: 

· Fatigue and/or dizziness.

· Pallor (pale skin color).

6. Nervous tissue damage. Anxiety may be first symptom.

 

7. Low strength, such as a weak grip.

 

8. Retarded growth in infants and children.

 

9. Hair loss.

 

Riboflavin may play a role in the prevention and/or treatment of carpal tunnel syndrome, migraine headache, rosacea, and vaginitis.

Food Sources of Riboflavin

Excellent: Liver, Kidney, Tongue, Brewer’s Yeast, Crimini mushrooms.

Very good: Romaine Lettuce, Asparagus, Chard, Mustard Greens, Broccoli, Collards, Clams, Eggs, Milk, Yogurt.

Good: Green Beans, Celery, Kale, Cabbage, Tomato, Strawberries, Cauliflower, Goat Milk, Raspberries, Brussels Sprouts, Squash, Green Peas, Oily fish (e.g., mackerel, trout, eel, herring, shad), Soybeans, Almonds, Beef Tenderloin, Pork, and Chicken Thigh.

Recommended Dietary Allowances for Riboflavin.

Pediatric

Children 1 to 3 years: 0.5 mg

Children 4 to 8 years: 0.6 mg

Children 9 to 13 years: 0.9 mg

Males 14 to 18 years: 1.3 mg

Females 14 to 18 years: 1 mg

Adult

Males 19 years and older: 1.3 mg

Females 19 years and older: 1.1 mg

Pregnant females: 1.4 mg

Breastfeeding females: 1.6 mg

Getting Your Daily Intake

In addition to making foods rich in riboflavin a part of your healthy diet, consider taking a multivitamin preparation containing 100% to 300% RDA in order to make up for any shortfall. Do not give riboflavin or any other supplement to a child without the advice of your doctor.

If you take medicine, there is a potential for side effects and interactions with all supplements. Discuss your optimum dose of riboflavin with your doctor.

Drugs that decrease riboflavin in the body include: the oral antibiotic tetracycline, birth control pills (oral contraceptives), tricyclic antidepressant drugs like Elavil or Sinequan, anti-malarial drugs like Primaquin, and Probenecid, an anti-gout drug.

Besides availability in multivitamin preparations, riboflavin is also provided as part of B-complex vitamin preparations and as a single vitamin preparation in 25mg, 50mg, and 100mg tablets (considered as medicine).

Take supplemental riboflavin with a meal for best absorption.

 

Impact of Storage, Processing, and Cooking

Riboflavin is destroyed by light. Food should be stored in dark containers away from the light to protect their riboflavin content. This is the reason for the switch from glass milk bottles to cartons.

Canned vegetables suffer the loss of 55%. Riboflavin can be lost in water when foods are boiled or soaked. If you do cook in water, be sure to consume the liquid. Riboflavin is not destroyed by heat, so vegetables are best steamed.

High-riboflavin foods should be cooked in covered pots whenever possible and stored in opaque containers. Without prolonged exposure to light, loss of riboflavin from cooking and storing is typically less than 25%.

Nutrient Interactions

Adequate supplies of thiamin in the body can help increase levels of riboflavin. However, very high levels of thiamin intake can cause the loss of riboflavin in the urine. Riboflavin plays an important role in making other nutrients fully available, especially iron, zinc, folic acid, niacin (vitamin B3) and vitamin B12.

Toxicity

Riboflavin is considered safe because excess vitamin is passed out in the urine. There is no documented toxicity.

References:

 

 

 

 
 

  1. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition, & Diet Therapy, 10th Edition. Philadelphia, PA, USA: W.B. Saunders Company, 2000.
  2. Cleo J. Libonati. Recognizing Celiac Disease, Fort Washington, PA, USA: GFW Publishing, 2007.  www.recognizingceliacdisease.com

-------------------------------- Author Information: Cleo Libonati, RN, BSN Cleo Libonati is president/CEO and co-Founder of Gluten Free Works, Inc. She is the author of Recognizing Celiac Disease. She can be reached by E-mail.

 

        


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5 Responses to “Understanding Riboflavin (Vitamin B2) Deficiency in Celiac Disease”

  1. Rita Perry says:

    Thanks a lot for posting your article. It was actually more helpful than our local pediatrician. This doctor prescribed my child vitamin B2 but had not told that it is destroyed by light! So, I kept storing the bottle on my bathroom shelf before I’ve read about dark food containers here.

  2. Dmitriy says:

    Thank, great post

  3. Meredith says:

    Hi, your information on Vit B2 is a very interesting read. I just wanted to add an added benefit. In 1976 when I was diagnosed with a cyst in my breast, the doctor at the time at the Rachel Forster Hospital in Redfern, Sydney, Australia, gave me Vit B2 to shrink the lump. Yes, to shrink the benign lump and guess what? It did. Doctors are hooked on weed killer to give to cancer patients by the pressure of the pharmaceutical companies but what about Vit B2? Has any research been carried out to see how beneficial it is for cancer? The answer could be that there is no money in it for the pharmo companies to pursue such research.

  4. Jay says:

    Make sure you replete with the active form, riboflavin 5 phosphate

  5. jessica prawitt says:

    thanks so much for this website it comes in handy at time. just read this article about riboflavin and i have almost every symptom that you put down. just want to say how thankful i am u published this.

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